What is ARFID? In the realm of eating disorders, there exists a lesser-known yet significant condition called Avoidant Restrictive Food Intake Disorder. While it may not get as much attention as other eating disorders like anorexia nervosa or bulimia nervosa, ARFID can have profound effects on an individual’s health and well-being. In this blog we will explore what is ARFID, its symptoms, causes, and potential treatment options.
In ARFID, people may avoid certain types of foods, leading to a restriction in the variety of food, or total calorie intake or often both. To be clear this is not about weight and shape but about the persons reactions to foods. ARFID can sometimes be known as extreme fussy eating. But let’s be clear, this very much is not fussy eating, it’s an eating disorder. People can struggle to eat certain colours, textures and be very brand specific with food. This is a condition that really needs a specialist feeding team and it is key to treat it quickly, especially in children who are still growing.
ARFID is not typically associated with a desire to control or change weight. Anyone can have ARFID unlike other disorders that are more associated with a set stage of life. ARFID can occur at any age and as early as two years old. It may co-occur with autism, ADHD and anxiety disorders.
Understanding what is ARFID
Avoidant Restrictive Food Intake Disorder (ARFID) is characterized by an extreme avoidance or restriction of certain foods or food groups, leading to significant nutritional deficiencies, weight loss, or impaired growth in children. Unlike other eating disorders, such as anorexia or bulimia nervosa, individuals with ARFID typically do not have a distorted body image or fear of gaining weight. Instead, their aversion to certain foods is often driven by sensory sensitivities, fear of choking or vomiting, or a lack of interest in eating.
People with ARFID may experience sensory issues around foods, such as the taste, texture, smell or appearance. This can make it difficult for them to tolerate a wide variety of foods. In some people, ARFID can occur after a distressing or traumatic experience such as choking. Other negative experiences with food, such as food poisoning, aversive reactions, or gastrointestinal discomfort, can contribute to an avoidance of certain foods or food groups.
ARFID can also occur where a person has a low interest in food or reduced connection with hunger cues. They therefore may have less of a drive to eat or interest in eating a variety of foods.
Top Facts about what is ARFID:
It is pretty new on the scene:
ARFID emerged as a new eating disorder in the DSM-V in 2013. Until this point it was known as selective eating or may have been misdiagnosed as fussy eating, picky eating or anorexia. Which is pretty eye-opening as sufferers would not have necessarily have been given the treatment that is right for them. Imagine being given treatment for a cough when you actually have tonsilitus. It is great that ARFID is now a recognised eating disorder but sad to think so many adults and children have been misdiagnosed.
ARFID is not rare:
It is thought that between 5-14% of children and adolescents with an eating disorder may meet the criteria for ARFID. The number of people with Avoidant resistant food intake disorder could range from 12,500 and 225,000 sufferers, according to Beat. ARFID can co-occur with autism and the neurodiverse population.
It does not just affect young children:
ARFID can certainly start in childhood and be diagnosed as early as 36 months but it can occur in adults too. It can be that someone has been misdiagnosed as a child and has struggled for years. Or it could develop later in life.
Signs you may see in ARFID:
- Sudden refusal to eat certain foods, colours, textures.
- Fear of choking, of vomiting, nausea, anxiety or having a reaction to food.
- Lack of interest around food.
- Only eating foods with certain textures, having a sensory element or requiring food to be prepared in a particular way.
- Delayed growth or failure to thrive in children or young adults, or weight loss in adults and older teenagers.
- Relying on nutritional supplements to maintain nutrition.
- Feeling full after eating only a few mouthfuls and struggling to consume more.
- Taking a long time over mealtimes or finding eating a chore.
- Sensitivity to the texture, smell or temperature of foods.
- Eating the same meals repeatedly or eating food only of the same colour, such as beige.
Causes of ARFID
The exact causes are not fully understood, but several factors may contribute to its development. These can include:
- Sensory sensitivities or aversions to certain textures, tastes, or smells of food
- Traumatic experiences related to eating, such as choking or vomiting episodes
- Anxiety or fear surrounding food and eating
- Developmental or neurobiological factors that affect appetite regulation or food preferences
- Environmental influences, such as family dynamics or cultural attitudes toward food
Unhelpful Phrases for ARFID:
Over the years I’ve seen many approaches to working with ARFID. Here are some that are largely unhelpful”
“If they are hungry they will eat – they won’t starve” – well actually someone with ARFID is not going to eat something that feels unsafe.
“Just keep offering and they will eat” – this can be quite degrading as a comment, someone with ARFID needs help to work through why they are not eating.
“Just try eating, it’s not hard” – it really can be very hard when you think the food is going to harm you.
“You used to eat it” – This may be true but things can change from day to day. Someone with ARFID can feel overloaded and overwhelmed which affects intake.
Instead of blaming statements it is so key to use lots of compassion and kindess, to help build food confidence.
Treatment for ARFID
Treatment for ARFID typically involves a multidisciplinary approach that addresses both the physical and psychological aspects of the disorder. Some common treatment approaches may include:
- Nutritional Counseling: Working with a registered dietitian to expand food choices, improve mealtime behaviours, and ensure adequate nutrient intake. This often involves starting with the list of safe foods eaten and thinking about why these are safe. This can help the team work out how to ladder and move to similar foods. There are so many other strategies to try include using food in play with children, exposure to food nearby but not having to eat it. It is key to let the person with ARFID be in charge and work with them. Using supplements and nutritional drinks can help to meet nutritional needs whilst other foods are being introduced. The aim is not for a perfect balanced diet but to meet the persons nutritional needs.
- Exposure Therapy: This involves gradual exposure to feared or avoided foods in a controlled and supportive environment. It is super important here to reduce anxiety and find ways to make this easier for the person involved. Distractions, the environment, relaxation techniques all need to be explored.
- Cognitive-Behavioral Therapy (CBT): The use of CBT in ARFID uses focuses on the why. Why are those foods unsafe. What happened in the past to trigger this. Then working on challenging negative thoughts and beliefs about food, building coping skills, and addressing underlying anxiety or trauma. this is key to do in a supportive way with lots of compassion. Remember working on ARFID is not easy, this is not someone being awkward around food.
- Family-Based Treatment (FBT): Involving family members in treatment is essential especially for children. But we all need a support group, to provide support, education, and encouragement.
- Medical Monitoring: Regular medical monitoring to assess growth, nutritional status, and any potential complications associated with ARFID is important.
As an eating disorder specialist and with a specialist interest in autism ARFID is something that I can support you with, so do reach out and we can chat.
Final word:
Avoidant Restrictive Food Intake Disorder (ARFID) is a complex eating disorder characterized by extreme food avoidance or restriction. While it may present unique challenges, ARFID is a treatable condition with the right support and intervention. By understanding the symptoms, causes, and available treatment options for ARFID, individuals and their loved ones can take proactive steps toward recovery and improved quality of life.
You can read more about eating disorder awareness week here and access 1:1 support in the Dietitian UK clinic.